Campbell BPH/LUTS Medical Management 2021 Flashcards
Frequency volume charts should be used during basic evaluation of ___ or ___.
Prevalent storage LUTS or nocturia
** FVCs = mainstay for assessment of nocturia
Nocturia definition
The complaint that an individual has to wake at night one or more times to void.
FVC duration: ___
3 days
Urine dipstick test and/or urine microscopy is suggested in ___.
Urine cytology should always be requested in men with ___, especially if they have ___.
All patients complaining of LUTS.
Severe storage symptoms and dysuria
A smoking history
The value of PSA testing i patients with LUTS (3):
Assess the risk and eventually rule out the presence of PCa
Estimate PV
Predict BPH-related outcomes
When to measure PSA: ___
Exception: ___
Measure PSA if diagnosis of PCa will change management.
Exception: life expectancy < 10 years
PSA level where PV would be > 40 mL in these ages:
50s: ___
60s: ___
70s: ___
PSA level at PV > 40 mL, at age ranges:
50s: 1.6 ng/mL
60s: 2.0 ng/mL
70s: 2.3 ng/mL
** Also cited in EAU guidelines
According to Guess et al., (1993), serum PSA level is reduced by 40-50% after ___ months of 5ARIs.
12 months
p. 3345
TRUE or FALSE:
GFR should be assessed routinely in patients with LUTS.
FALSE.
Serum creatinine may be assessed if renal impairment is suspected based on medical history or if surgical treatment is considered.
MTOPS: <1% of men with LUTS experienced kidney failure over a period of 4 years.
PVR volume regarded as important: > ___ mL
< ___ mL is considered nonsignificant
> 50 mL = important
< 30 mL = nonsignificant
- Ultrasound should be used to assess PVR volume
- Abnormal PVR NOT highly correlated with BOO (can also be DUA)
PVR volume should be assessed during ___.
During basic workup and follow-up of patients with LUTS
** Monitor PVR closely if patient chooses nonsurgical therapy.
Uroflowmetry main parameters
Qmax (peak urinary flow rate/PFR)
Voided volume
Flow pattern
PFR cutoff ___ could be used to define BOO, but does NOT differentiate between obstruction and bladder decompensation.
15 mL/s
** Uroflowmetry is optional in LUTS, but recommended before any active treatment.
The gold standard for assessment of LUTS pathophysiology.
Characterized by 2 evaluations: ___ and ___
Invasive urodynamic test
Filling cystometry and PFS
** It is used to identify DO, DUA, low bladder compliance, and BOO
Cystometry assesses the ___ phase, detects ___.
Storage phase
Involuntary detrusor contractions, which may identify DO.
** DO = may benefit from anticholinergic drugs alone or in combination
PFS assesses the ___ phase.
Differentiate: BOO and DUA based on flow rate and detrusor pressure
Voiding phase
Detrusor pressure and flow rate
BOO = impaired flow rate with increased detrusor pressure DUA = impaired BOTH flow rate and detrusor pressure
Urodynamics NOT recommended routinely for LUTS, except in these specific scenarios: (5)
- Previously unsuccessful invasive treatments for LUTS
- Cannot void more than 150 mL
- PVR volume greater than 300 mL
- > 80 years of age with predominantly voiding
LUTS - <50 years of age with predominantly
voiding LUTS
ALSO: PFS for patients with Qmax >10mL/s before surgical treatment is considered
TRUE or FALSE
Routine upper tract ultrasonography is recommended in patients with LUTS.
FALSE.
** Imaging assessment of the upper tract is currently suggested for patients with LUTS combined with an elevated serum creatinine level or large PVR volumes.
ALSO: History of hematuria, UTI, urolithiasis, or prior urinary tract surgery
Prostate volume should be assessed by TRUS/suprapubic before: ___ or ___
5ARI treatment
OR
BPH surgery (to choose most appropriate technique)
Cystourethrogram is suggested for: ___
Additional diagnostic test when urethral strictures or bladder anomalies are suspected.
TRUE or FALSE
Cystourethroscopy is useful for the diagnosis of BOO and to determine the need for treatment.
FALSE.
A poor correlation between BOO and cystourethroscopy findings has been widely reported.
USE FOR: gross hematuria, bladder CA, recurrent UTIs or urethral injury, previous urethral or prostate surgery
Watchful waiting rationale
A number of patients with LUTS suggestive of BPH are affected by an indolent, nonprogressive disease that does not require active treatment.